Brian and Ashley called me about the upcoming birth of their second daughter.Their firstborn, Naomi, is two years old (and adorable, btw) and they were expecting baby girl #2 on 11/11/11.

I remember the first night I met with them. Ashley was telling me that she really would like a different experience than her first birth, but she was concerned that she wasn’t exactly sure she would be able to handle a long labor with strong contractions. I assured her that not only did she have “what it takes” but also I am sure that she would do wonderfully!

Fast forward to November 7th. At 4:30 a.m. Ashley woke up and realized that there was some leaking of something.She called me at 6:30 and told me what she experienced.Based on the amount she described, I thought it could be the fore bag or urine.Yes, at the later stages of pregnancy you can pee on yourself because of all the pressure of the baby. I recommended she keep and eye on it, if she had any more leaking to let me know.She called again at 1 p.m. and said that she had some liquid trickling down her leg. At that point I was sure it was amniotic fluid, but just not sure, again, if it was a fore bag or a slow leak of her bag of waters.

She decided to head to the doctor’s office at about 3 p.m. just to check because she didn’t want to second guess herself that it was actually amniotic fluid.He said it was in fact amniotic fluid, which meant that, because she was Group B+ she would need to go on in to the hospital to get her antibiotics, even though she was about 2-3 cm’s/80/-1 with minimal and sporadic contractions.She decided to head home first and get things settled there before she would head to the hospital.Most of the day she had no major gushes of fluid, just occasional streams.

She called me at 6:30 and said she would like for me to come over. Her contractions were still sporadic at about 8-15 minutes apart lasting anywhere form 30-60 seconds.I arrived at her house at 7 p.m. and after a call to the doctor and lots of discussion, they decided to head to the hospital to start the antibiotics.

Upon arrival, she was found to be 2-3/80/-1, same as earlier.Her contractions were coming about every 6-8 minutes but were “just uncomfortable” as she described it.At 10:30 I recommended that they try to get some sleep and that I would head back to my house and that she should call if the intensity changed at all.

At 3:15 a.m. Brian texted me to say that Ashley’s contractions were 3-6 minutes apart lasting about a minute and she was on the birth ball beside the bed and he was applying counter pressure, and that she would like for me to head their way.

When I arrived at 3:45 a.m. they were still beside the bed just as Brian had described.Ashley was in great spirits, and quite honestly it was hard to believe that she was actually in labor.She was ready to get things moving along and wanted to walk the halls.She had the option to have a vaginal check to see her progress, but given that she didn’t think the contractions were that painful, she was afraid to find no progress.So she declined the check and to the halls we went.The contractions picked up their frequency and she would do the “prom dance” with Brian while I applied counter pressure.We walked for about 35 minutes and then she said she would like to head back to the room to get in the shower.At this point, (strictly from the doula perspective) she seemed to be in a steady pattern, but wow, either it didn’t hurt as much as I thought it should have or this woman is a rock.Or both.

After about 10 minutes in the shower her demeanor changed. She became very internal, less talking in between contractions and then she had two contractions back to back.Yep, evidence of transition (7-10 cm’s).She had six contractions (in the patter of two back to back) and on the last set of two, she started to moan.She said she felt a burning in her lower abdomen but no mention of pressure.At that point I thought to myself, “After this next contraction I think I should get her to empty her bladder and then head to the bed to rest on her side, if she is willing, since she walked and has been standing in the shower. . .” No sooner did I have that thought, did she start the next contraction, and where I thought she was standing up to position herself against the birth ball (that I propped in a chair next to the shower) she grabbed herself and with full conviction and a bit of panic said, “THE BABY IS COMING!!”

I laugh at the next words that came out of my mouth. Please hear me out on this.When it’s your first time to experience a natural birth, it is so very common to be surprised by all the new feelings, especially the amount of pressure or the intensity of it, as baby descends down your pelvis.So I said, thinking that she was likely feeling that pressure, “Oh Ashley that’s GREAT! Is that pressure you are feeling?” to which she looks at me and says again, “NO, the BABY IS COMING RIGHT NOW.” And then she sprints right past me (yes, sprints) and onto the bed, leans back and I dare to look down to find the baby’s head crowning, nearly out.

NUUUUURSE!!! I had to page the nurse and yelled, “Ya’ll need to come now, the baby’s head is out!” (At least that is what one of the nurses told me later, that I said). And yes, she said I did sound panicked. Her doctor wasn’t in there immediately but a doc from another practice was at the nurses’ station when I called out so he came. He was very nice and then after one more contraction, the main doc arrived.

Ashley was laughing and smiling in between contractions and after about three contractions and at 4:55 a.m. (one hour from when I arrived back to the hospital) she delivered her baby girl, Cora! She was 8 lbs 12 oz and 21 inches long on November 8th!

I still just get so tickled when I think about that moment in the shower.The three of us just couldn’t stop talking about it. It all happened so quickly.And because ol’ strong momma was, as her husband affectionately called her, “a beast” she was able to internalize her process and made the rest of us think we had hours to go.

Ashley, I am so super proud of you.You did such an amazing job, even in the face of unknowns and a possible change in your birth plan.But ultimately it all worked just the way we had prayed and I am sure that you believe me that you always had what it took.Congratulations on your beautiful baby girl!

I’ve received several emails from moms, seen birth stories go awry and known people, who are completely unaware of one simple fact: a doula is not in control of your birth.

You are.

With that said, just as finding the right doctor is important, the right birth place (hospital, birthing center or home) and having the right birth team are all crucial to a great birth: nothing holds the “power” over your birth like you do.

Let me explain.

Moms are growing more aware that they may meet some resistance with their birth plan/vision therefore they enlist the help of a doula. The intentions are different for everyone, but I have seen many a couple shocked to hear that the doula’s role should NOT include making decisions “on your behalf.” Meaning, you’ve written a birth plan and now it is up to the doula to make sure it happens.

1. Mom is the only one that can consent to anything. The opposite is true as well. If you have on your birth plan that you want skin to skin with the baby immediately and any procedures that need to happen can happen while baby is on your chest, and the nurse has the baby and is trying to get all her “stuff” done as quickly as possible, the doula can say, “Can we get baby to mom for skin to skin now?” If the nurse shows any resistance, as a doula I can only repeat my sentence. But if mom, who wants her baby, looks over and says, “I’d like to hold my baby now.” Guess what? They do it. And even if they say, “oh but i was just going to do this one last thing and be done.” If that is not what you want . . . YOU (alone) are the one to say “No thank you. I want to have my baby.”

This is true with anything on your birth plan. If you are being asked to do something that you don’t want to do, the doula is not in the place to answer for you. You have to speak up. Because even if your doula does say “she doesn’t want to do that,” everyone else in that room (including the doula) knows that it holds no water if the momma doesn’t say it. You see, you are the patient. Informed consent only applies to you. Not to your husband and not to your doula.

What the doula does: the doula can remind the doctor/nurse of your birth plan, and advocate for those items, but they can not “make” anyone do anything. Especially if it means an argument would ensue between her and the staff. That is NOT the role of a doula.

2. A doula does not give medical advice. On your last prenatal visit your doctor recommends that you get an induction. You immediately call your doula to ask what she thinks. Instead of opening up a long discussion about how insane your doctor is, your doula should respond in a different way.

What the doula does: The doula should help get information to you that would help YOU make a decision. The doula’s role is to help you realize that YOU have what it takes to make the best decision for you and your baby. Not based on what the doctor thinks OR what the doula thinks. **Everyone has an opinion, the doctor as well as the doula, but the ultimate decision is yours and both (doctor and doula) are to support you in whatever you decide.**

3. A doula does not guarantee birth plan success. However, it does increase it. Yes, there are studies showing the continuous support of a doula does increase your chance of having the birth you planned for. However, there are times where changes are necessary. Medically necessary.

What a doula does: A doula’s role in the face of a change in the birth plan is to buy you time for the opportunity to discuss it with your partner. If the doctor comes in and says that he thinks it’s time to consider pitocin, the doula may say, “Jason and Samantha, would the two of you like some time by yourselves to discuss what you want to do?” The goal there is not to say, “umm, I think ________” because doula’s don’t give medical advice. We can guard your space and allow you the time to make the decision for yourself. **I am aware there are times where time is of urgency, in those times it is different. But in most cases there is time for you to have a discussion to determine if there are other options.**

So you may be left asking yourself, “why do I need a doula then?” A doula knows the process of birth, is a huge resource for physical support, suggestions for comfort as well as tips to get labor to progress naturally. A doula helps you from start to finish and never leaves your side. A doula is there to support you and what you decide, and to offer information (covering all sides of a decision) to help you know your options. Just like you don’t want your health care provider making decisions for you, same goes for the doula.

Jenna and Chris contacted me while they were still living in Boston. They were planning the move to Birmingham (for Chris’ residency at UAB) and were wanting to go ahead and interview a doula for their upcoming birth. Thankfully, they hired me and the waiting began. Jenna also decided that she wanted to do a Hypnobabies birth. I went to their last class (taught by fellow doula, Kaleigh Naylor) so that I could learn how support them in that effort (since I was new to Hypnobabies). It all seemed pretty interesting and I was excited to see it in action. **There is a lot of “reframing” in Hypnobabies, so in honor of that, I will refer to contractions as pressure waves (pw’s) for this birth story** 😉

On September 14th at 40w2d, Jenna texted me at exactly 4 pm and said she was having a lot of irregular pressure waves, all happening since around 11 a.m.She said she was still doing “normal” stuff (like chatting with friends online) and would let me know of any changes. She said they were lasting about 30 seconds and some for a minute but didn’t give me a time for how far apart.

Two hours later she was still having waves and I asked if she’d be up for an after dinner walk (to see what the pressure waves would do) followed by a resting period (again, to see what the “pw’s” would do). She was up for it and said she would let me know the results. So two hours later she texted me and said she had finished her walk and was lying down. During the walk the pw’s moved to 3-5 minutes apart lasting 30-60 seconds long. And then as she was lying down: they stayed the same. (YAY!)

At 9:30 p.m. they emailed me the pressure wave list from their phone app (very cool). And from that I could tell that they were still sporadic (anywhere from 3-9 min apart, lasting max 45 seconds). So I suggested they follow their normal routine for this time of day (namely, try to go to sleep), and to let me know when the pw’s picked up in duration, i.e., 45-60 seconds. Jenna decided she would listen to one of her hypnobabies cd’s and then lie down.

At 11:30 Chris let me know that the last 4 pw’s were 1 minute long and intense enough to cause shaking.She also had a bit of nausea.I asked if they would like for me to come and they said yes.

I got to their house at about 12:15 a.m. When I came in, Jenna was in her bedroom sitting on her birth ball and looked beautiful. She was so relaxed and was listening to a hypnobabies music track.After getting there I asked if she’d be up for a walk around the house (inside) and she was. The pressure waves were 2-4 minutes apart lasting 45-60 seconds long.She and Chris would do the prom dance whenever a wave came.Then after some more time on the birth ball, I suggested that she try and get some “rest” (code for sleep, in between waves).So at around 1:45 she got in a side lying position on her couch.She also put in another hypnobabies track and got some good rest in between waves, for at least an hour.(I also suggested that Chris go lie down as well as he would need the rest too, and I would wake him up when things changed).

Laboring at home (pictured below).

So an hour later, Jenna was making beautiful progress.It was obvious that the waves were getting stronger and I asked if she would be up for transitioning to the hospital.She agreed and said she would rather transfer before the waves were more intense.(Again, trying to not to have a momma do transition in the car).

We got to the hospital at 3:00 and she was asked to go to the triage room first.She was found to be 6/50/-2.She got back to her room by 3:45 and the nurse we had (Emily) was amazing.She asked if there was anything we needed and if not, she would just slip out and come check the baby every 30 minutes.AWESOME.Over the next three and a half hours Jenna was amazing.She was able to use all sorts of comfort techniques including: walking, the birth ball, getting in the shower and resting in the bed.She handled transition (transformation) beautifully.At one point, when she was lying in the bed, getting rest in between pressure waves, I texted Chris (yes, we were both in the same room, but you gotta be quiet, you know) that I think it would be helpful for Jenna to stand up for a few pw’s to enable the baby to labor down.She stood up, had two pw’s and then a big gush!! YAY, her water broke.A few pw’s after that, she had the urge to push.

She made her way to the bed, to try out the squat bar. That wasn’t exactly what she wanted, so she moved to standing at the end of the bed and used the bar to support her arms. Then I suggested she sit in the bed, leaning back, and use the towel (around the squat bar) for leverage to pull with. That seems hard to explain, but it worked well. In just a short time, baby was crowing. Jenna also used the mirror, which was allowing her to see her progress and give her a visual as to what “kind” of pushes were more effective.

I should also note here that the doctor and the nurse were both in the room, but they were not saying anything, but smiling and giving occasional words of encouragement.They were allowing me to give suggestions to Jenna and allowing her to push as she felt she needed to.They were totally letting us do “our thing.”After about 45 minutes of pushing, at 7:18 Jenna pushed out her beautiful baby GIRL, little Iyla Rose weighing in at 7 lbs 5 oz.She is so beautiful.

Jenna also had two requests on her birth plan that I was curious how they might be handled at UAB (since this was my first birth at UAB): delayed cord clamping and natural detachment of the placenta. The longest I’ve seen a doctor wait on a cord to stop pulsating is 3-4 minutes, max.Well, Jenna’s cord was, as the doctor described it, “the little cord that could” and it took 28 minutes for it to stop pulsating.Which means that the doctor left it alone for 28 minutes and not only that, she was happy to do so. Okay . . . well surely once it’s clamped they will start applying traction to detach the placenta. The doctor, however, told me to watch for the “show of blood” and that’s when we would know the placenta was detached (UAB is a teaching hospital, can you tell?). So one hour after Iyla Rose was born, the doctor said that the placenta was fully detached and mom could push it out. Which she did. Not one pull was done before it was completely detached. And I can say that I have NEVER seen that done.

Also, after baby Iyla was born, we had shift change and got another nurse. Her name was Shelia. And she was so cool. She is actually studying to get her masters in midwifery there at UAB and we had so much fun talking all things birth, eh hem, natural birth in a hospital setting. She and the doctor even brought over the delivered placenta to show it to Jenna when she asked a question about how it was attached.

The entire time all this was going on, Jenna had her baby in her arms. Well, she did share Iyla with Chris at one point so that she could go to the bathroom. And when I left (two hours after the baby had been born) the baby had not been weighed yet, nor had she had any other procedure done. She was still with her mommy and daddy. It was just beautiful.

Jenna and Chris did such an amazing job. The Hypnobabies scripts really helped Jenna to focus and UAB was stellar. The nurses and doctors made it awesome. In fact, Jenna texted me the day after and said that when the doctor came by to say hey, he told her it was the best birth he had ever witnessed. And that is a pat on the back to no one and nothing but Jenna and Chris! She is the one that did all the work and she did it very well!

Good job you guys. I am so proud of you. And honored to have been invited to your big day.

Melissa called me while in her third trimester. She was referred by her pediatrician (a dear friend of mine) after she told her that she was curious about doing a natural birth. You see, just like me, Melissa had three prior inductions and had never had a spontaneous birth. But she wanted one. So after meeting with Melissa and Bobby, she was sure she could do it and I was thrilled to be part of their process.

Not only did Melissa get the opportunity to trust her body during birth, she also got the opportunity to trust God in His design during pregnancy because her due date came and went and seemed like the spontaneous labor would never happen. At 41w2d (September 9th) she had a doctor appointment. After Melissa’s doctor’s appointment she texted me to say that everything was the same as the last appointment: 4/100/-3. She said that she had her membranes stripped again but didn’t have much faith in it working.

At 1:19 she texted me and said she had been having ctx’s since she left the office and when she timed them they were 7 mins apart lasting 45 – 60 seconds in length. GREAT! She decided to lie down to see what they (ctx’s) would do. They stayed steady and she felt better while lying down.

At 2:30 she let me know they were about 6 mins apart and that she was getting in the tub. I got to her house at about 3:40. When I arrived she was on her knees with her arms draped over a pillow on the couch. Bobby was behind her, rubbing her back. The contractions were coming every 3-4 minutes and she was handling them beautifully. They were about 60 seconds long. She was breathing nicely and was very calm and controlled. She walked some and lay down as well.

(laboring at home)

About an hour later, she was on the birth ball leaning against Bobby with me behind her applying counter-pressure to her lower back. It was in this position that she started to moan for the first time.

She communicated earlier that she wanted to stay at the house and labor there for as long possible. We also had to take into consideration that on a good day (without traffic) they live about 30 minutes away from the hospital. But the baby decided to initiate labor when we would need to transfer in rush hour traffic, at 5 o’clock on highway 280.

Once she started to moan with her contractions I suggested that we head on to the hospital. I was confident that, while she was not in transition, she was very close to it and NO ONE can predict how long or short transition will be. They agreed and we made our way to the hospital at 5:15.

We pulled up to the hospital 6:05. When I got out of my car I saw Bobby making a sprint for the door: without Melissa. I was fully aware that since I don’t ride in the car with the clients, but follow behind them in my own car, I am unaware of what actually happens during that ride to the hospital. But when I saw Bobby run to the door and then answer me with “she can’t walk. She isn’t going to walk.” I was VERY confident that (evidently) she had probably started transition on the way over. Once I walked to up to her at her car, I was SURE she was in transition. I said, “Hey Melissa, what’s going on?”

“I WANT AN EPIDURAL NOW!”

Yep, transition. For those that don’t know: the emotional signpost of transition is “self-doubt.” When you think either, “I don’t want to do this anymore,” or “I can’t do this anymore.” And that just means one thing: you are about to hold your baby. It also means (for the doula) that I better get you to your room pronto so that we can make you more comfortable and help you gain your bearings again. The car ride over (especially if you are in transition) can be one of the most difficult parts of the birth story. It’s hard to get comfortable, on top of the “self-doubt” thoughts you may be having.

So a nurse came out with a wheelchair and we got Melissa to her room. When she got in the room, she stood up beside the bed, leaning on the birth ball. She had two contractions there and then headed to the bathroom to try and give a urine sample (yeah right) and change clothes. When she sat down on the toilet she had a very strong contraction with a lot of pressure and expressed that she did not want to do this anymore (all very normal). At that point I had her look right into my eyes and hear me: You are about to push out your baby. You are no doubt 10 cm’s and you are doing it! Lets get you settled and into a comfortable position okay? Lets do one contraction at a time, okay?

She agreed and then immediately started another contraction and then announced “the head, the head!! IT’S COMING!!” She stood up a little off the toilet and, because I was the right there in front of her, I instinctively reached to make sure I could support the baby’s head. But what I felt was more squishy and felt like a balloon. A balloon full of water. Yup, I was supporting the BOW (bag of waters), intact. AWESOME! I have never seen that before. So I called out to the nurse (who had run out to find a doctor) that it was the BOW and she came back and helped us get Melissa to the bed. She managed to get in the bed and seated upright when the next contractions came and then that bag of water (outside) ruptured.

After a few more contractions Melissa told us that she wanted to get on her hands and knees. At that point she was in the bed on her knees, upright and leaning on Bobby. She was bearing down, but was having trouble staying upright, and Bobby’s arms were taking a beating. So I asked her to get in the same position (since she liked it) but instead to lean over the head of the bed. Magic.

She began to push and in just a few contractions the baby’s head was out. And then at 6:36 her beautiful baby girl was born: Katelyn Grace, 8lbs 4oz and 19 ¾ inches long. Little Katelyn was perfect, with the prettiest pink skin you’ve ever seen.

So just 30 short minutes after getting to the hospital, Melissa pushed out her baby. Wow.

Melissa, I am so thankful. Beyond thankful to watch your process. You did an amazing job. You were in control of EVERY.SINGLE.CONTRACTION. You were so strong and handled that car ride like a rock star. You are a natural pro and I am so proud that you waited patiently for your body to do what it was created to do. And as I said on that day, we are now best friends because your music playlist was a copy of my own. 😉 And Bobby, you were stellar. Strong and confident for Melissa. Being a physician suits you. But being Melissa’s coach, beautiful. You guys are an amazing couple to watch and I am thrilled that you didn’t have to run any red lights, even though you wanted to. You both did amazingly! Congratulations on that beautiful girl.

SHOUTOUT: While I don’t have the permission of the doctor and nurse involved in this birth (to use their names) I want to make it known how amazing both were. I am always amazed at this doctor’s calmness and willingness to let mom do what she wants to do to be comfortable (namely, pushing in whatever position is most comfortable for momma). And I’ve worked with this nurse before and loved her then too! I can’t say enough good things about Brookwood!

I had the honor of working with Julianne and Micah 19 months ago when they welcomed their son Jeremiah into their family (click here for that birth story).And now she was expecting her second son, Levi Everett on August 4th.

Julianne had a complication free pregnancy but did test positive for Group B strep.Funny thing happened: once her due date came, she went to the doctor the day before her EDD only to find out that they had her due date as the 4th instead of the 6th, as she thought.So when she thought she was a day away from her EDD, she realized she was actually already a day “late.” No worries though, because her doctor was happy to support her going to 42 weeks.So the waiting began.Then on August 11th she went to her 41-week check up and decided to get her membranes “stripped.”

After leaving her appointment she said she had contractions periodically throughout the rest of the day and then around 6 o’clock that night they became more consistent.She texted me around 7:30 p.m. and said they were coming every 5 minutes or so, but only lasting about half a minute.Since she had been up cleaning I recommended she try to lie down for 30 minutes and see what happened, to time a couple (in length) and let me know of the change.After 30 minutes she called and said once she laid down they went to every 6-7 minutes but were lasting about a minute! GREAT!! At that point she was comfortable and didn’t feel she needed me there.So we texted back and forth over the next hour and a half and at 10 o’clock she said that she just had 2 contractions that were 10 minutes apart but were 2 minutes long.(That is code for: great cervical change. No doubt).So I was asking if I could come over (please???).I jest, because, Mrs. Julianne is a rock star.She is great at concentrating through contractions; staying on top of them and making it truly look easy.I totally understand that on the inside, there may be a different battle going on but to us outsiders, she truly is amazing to observe.

So at 10:45 she tells me to head on over.I got my stuff ready and headed her way.I got to her house at about 11:30.When I walked in the door she was kneeling in front of the couch with her upper body leaning against the couch.Micah (her wonderful husband and awesome coach) was putting counter pressure on her lower back.Julianne was moaning very nicely through the contractions that were coming about every 4 minutes and lasting about 60-80 seconds.

(laboring at home)

Knowing that Julianne was getting close, I knew we needed to head to the hospital because she wanted to make sure she had enough time to get her IV antibiotics.(Now, while I knew she was close, it would turn out that she wouldn’t get her full dose of those antibiotics.)

After about 15-20 minutes I suggested we make the 8 minute drive to the hospital.While I knew her emotional signpost was indicative of beginning transition, I knew with her BOW still intact, we had time to get her there without having to do all of transition in the car.

We get to the hospital and (8 minutes ya’ll) Julianne is fully complete: 10/100/0!! (At 12:15 a.m.). Yes, that is right.Her water is still in tact and the baby is still at 0, so there is still some time.At that point Julianne uses the squat bar (leaning over it) to work through some contractions, and then I suggest leaning over the back of the bed to give her legs a break.After 30 minutes she was checked again and was still 10/100/0.At that point I told her that if she would stand beside the bed, lean her upper body against the birth ball and rock her hips side to side through the contractions, I was convinced that she would be pushing very soon.She needed gravity and the moving of the pelvis to help baby Levi labor down.

So she did, and had two contractions and then her BOW ruptured (12:51 a.m.).AWESOME!! I reminded her that the contractions may feel a bit more intense but that she could do it and she was about to meet her baby.Then on the third contraction she said, “I am really having to push now!” (Before she had been bearing down, but now the urge was involuntary).It’s amazing how the body just takes over as you work with it!

She decided to go the squat bar and after about three contractions, the head was crowning.At that point she said she really wanted to lean back (to a upright seated position) and within a few pushes she pushed out her adorable baby!! And Micah got to help deliver!He had gloves on and helped catch!And that precious boy was 8lbs 1 oz. and 20 inches long.(1:06 a.m.)

He was immediately able to nurse with success and after he nursed on one side and Julianne was burping him, I suggested that maybe she could try the “Breast Crawl.”So she placed Levi in between her breasts and as I am saying, “well it may take a baby up to an hour to find the nipple..” wouldn’t you know that boy immediately lifted his head straight up, bobbed several times and successfully latched on in under a minute. I don’t think I had even finished my “spill” about how long it can take, and that boy was done!It was so beautiful to watch!It’s amazing how they know what to do!

Once again, Julianne you were amazing.And Micah, I am sorry I butchered Everett and confused it with Everest.You already know I’m kind of loopy sometimes.I am so proud of you both and excited for your growing family!May the Lord continue to bless you!

A doula offers constant emotional and physical support during the process of labor and delivery, as well as postpartum. A doula helps ensure that you have the information you need to make informed decisions regarding your baby’s birth.

AS YOUR DOULA,

I will provide continuous emotional, physical and informational support during your labor and delivery. I can provide reassurance and perspective to you and your partner, make suggestions for labor progress and help with relaxation, massage, positioning and other techniques for your comfort. I will use my training, knowledge and experience to help you achieve the birth you have been planning and waiting for.

WHAT SWEET BIRTH DOULA SERVICES PROVIDES FOR YOU:

-Assistance with the completion of a written birth plan.

-An initial meeting to discuss your birth wishes

-One or two prenatal visits to finalize your birth vision/plan

-24 hour on -call availability from three weeks before your due date until labor begins.

-Assistance in managing unexpected circumstances with compassion and knowledge.

-labor support

-Postpartum visit.

FEES:

$750

$375 retainer fee due at the time you decide to hire me (but after the initial meeting to determine if you want to add me to your birth team). And the balance due by 38 weeks.

“Rachel has been my doula for the last 2 out of my 3 births. I can’t recommend her highly enough! She is extremely knowledgeable and encouraging, which made me more confident. She is strong, relaxed and really helped put my husband and me at ease. She was most concerned for the well being of our children and me, but she was also respectful of the hospital staff. Not only did Rachel help me achieve two unmedicated births but she taught me a lot about birth and really helped me grow a passion for natural childbirth.”

– G.C, mother of 3.

“We contacted Rachel soon after learning we were expecting, and her guidance and support throughout the pregnancy were invaluable. She was our doula for months – not just on our son’s birthday. Her willingness to listen, answer questions, and encourage us through texts, emails, and phone calls meant so much to me. Her demeanor was always positive and respectful as an advocate for me, and cooperative with the attending staff, which gave me great peace of mind. I can honestly say that our experience was a beautiful, joyful occasion and I would highly recommend her services as a doula. I cannot imagine that day without her beside us, helping to meet our needs, and cheering us on.”

On the first day one of the other sessions was, “Can VBAC’s Make A Comeback In The US?” by Dr. Eugene Declerq. (please understand these notes are not exact quotes)

*He asks “whats the link between research, evidence and practice? NONE. It’s about cultural practice. That is what is determining what the numbers are.”

*5 things you might not have known about contemporary VBAC’s:

1. Things are maybe not so bad for vbac’s. there is a tendency for vbacs to be under counted in vital statistics systems. *same is true for repeat cesareans.Because on the birth certificate there isn’t an option for vbac, only vaginal or cesarean. So technically the vbac counts as a vaginal. This changes how the numbers are reported. Alabama ranked number 4 in the lowest vbac rates.

2.The falling rates of VBAC have nothing to do with maternal risks.Simply having had a prior cesarean is the only indicator.

3. The relationshipbetween vbacs and primary cesareans.The debate over vbacs is not extinct from the debate.Increasing the VBAC rate will likely be related to decreasing the primary rate. (primary=first time cesarean).

4. Is there a trend toward home VBACs? Yes.

5.Things will get better for vbac’s. How much worse can they get? (sadly, this is true) NIH meeting, new ACOG guidelines.

ERCD-26/100k (Risk increases with the number of prior cesareans). (can’t find the year or study name on this one.. although I think it was in the green journal).

Interestingly enough this session was a tad bit depressing. Because what would have to change is first, how vbacs are reported, but also this has a lot to do with cultural practice and if a doctor has had an adverse outcome or not. Also, the insurance companies and malpractice insurances are going to have to reform before you see more acceptance of VBAC’s. Even though ACOG made some recommendations that were to be a help to those wanting a TOLAC, they still made recommendations (in their own Level C.. based on “expert opinion” not RCT’s) that are not based on the evidence (RCT’s). So at the end of the day the hope is that things get better because, how could they get worse? Oy.

*When physicians are making policy for their practices, generally it has an “order” to it.

1.RCT’s (Random controlled studies)

2. Observational Studies

3. Expert Opinion

Those are the scientifically “accepted” method of deciding what practices you do. But someone came up with a fourth criteria that seems to be jumping on the list:

4. Adverse outcome. And sometimes, even if the RCT’s and science supports a particular practice, if a doctor sees an adverse outcome they will ban it from their practice all together.

(EX: if there is a 1% chance of uterine rupture, and they will ban VBACS all together. Rather than accepting that the opposite is true-per the same study- that there is a 99% chance that you won’t experience a uterine rupture).

*Daddy Skin to skin- even 15 minutes in the first 24 hours: promotes protectiveness, more likely to call the baby by name (instead of “it” or “the baby.”), better understanding of babies cues and promotes closeness toward the baby.

ONLY 6% of ALL births have “NO complication” according to the 2011 review of Insurance billing records of 2008. There is a high incentive to bill more instead to promote health or prevention.

*In the 94% reported as complication here is a breakdown of some by definition: “complicating conditions high rates of minor or modifiable risk factors and preventable complications”- Nukal cord 18%, maternal age12%, prolonged pregnancy-12%

*High prevalence of diagnoses based on unreliable screening tests or subjective clinical judgment – gestational diabetes-17%, abnormal fetal heart tones-17% (meaning these are diagnoses based on interpretation.. different doctors can look at the same EFM strip and make different diagnoses).

*the high % of “complications” were caused by overuse of questionable medical procedures (induction, c/s, episiotomy)

*Payment tied to number or procedures-incentive to dx high risk & disincentive to promote health and prevention

* Even telling a mom, “you’re breathing too fast,” “keep those sounds low”.. she may feel shame “Oh I’m not doing it ‘right’.” . we must be careful not to do that. Rather word it “with thenext one try this..” We are doing everything we can to help the flow of oxytocin and shame will cut it off. Yes, there are times where we do have to ask mom to give a little more effort (ex: pushing) but we must know how to communicate that positively).

*Pushing-If she is squatting.. she should not be doing the hard bearing down counting to 10.Sometimes we do have to ask for her to give some more effort if the baby is malpositioned. But there is enough pressure on her perineum that she does not need to force it. Let the baby rock back and forth, in and out of the “crowning”.. good for babies head and for stretching moms muscle.

*Penny Simkin does not like the words “tear or rip” and prefers to re-frame it as a “tissue separation.”

*We know that intravenous hydration may lead to: inconvenience and discomfort to mother, fluid overload, hyponatremia (loss of sodium= foot and hand swelling that can last for days), mother feeling deprived of basic comfort. But there is a CAUTION: too much oral fluid can lead to fluid overload and hyponatremia as well (Moem Study). We can trust the mom on whether she wants to drink or not. Don’t “make” her, suggest it to her.

*Penny Simkin loves epidurals for exhaustion. For the mom that has labored over 24 hours. (if they are exhausted). Because the epidural keeps a mind/body split. When the mind is out of it for labor, the epidural allows her to relax and frees her up to labor (especially during exhaustion).